<?php defined('InShopNC') or exit('Access Invalid!');?>
<div class="quick-login">
    <form id="login_form_<?php echo $loginId=isset($_GET['rand'])?(string)$_GET['rand']:mt_rand(10000,99999);?>" action="<?php echo SHOP_SITE_URL;?>/index.php?act=goods&op=apply_book&domId=<?php echo $loginId;?>" method="post" onsubmit="ajaxpost('login_form_<?php echo $loginId;?>', '<?php echo SHOP_SITE_URL;?>/index.php?act=goods&op=apply_book&domId=<?php echo $loginId;?>', '', 'onerror');return false;"  class="bg" >
        <?php Security::getToken();?>
        <input type="hidden" name="form_submit" value="ok" />
        <input name="nchash" type="hidden" value="<?php echo getNchash();?>" />
        <input name="goods_id" type="hidden" value="<?php echo $output['goods_id'];?>" />
        <input name="rand" type="hidden" value="<?php echo $loginId;?>" />
        <dl>
            <dt>姓名：</dt>
            <dd>
                <input type="text" class="text" autocomplete="off" value="<?php echo $_SESSION['member_truename']?$_SESSION['member_truename']:''?>"  name="user_name" id="user_name">
            </dd>
        </dl>
        <dl>
            <dt>手机：</dt>
            <dd>
                <input type="text" class="text" name="mobile" autocomplete="off" value="<?php echo $_SESSION['member_mobile']?$_SESSION['member_mobile']:''?>"  id="mobile">
            </dd>
        </dl>
        <dl>
            <dt>预定数量：</dt>
            <dd>
                <input type="text" class="text" name="number"  autocomplete="off" value="1"  id="number">
            </dd>
        </dl>
        <?php if(C('captcha_status_login') == '1') { ?>
            <dl>
                <dt>验证码：</dt>
                <dd>
                    <input type="text" name="captcha" class="text fl w60" id="captcha" maxlength="4" size="10" />
                    <img class="fl ml10" src="<?php echo SHOP_SITE_URL?>/index.php?act=seccode&op=makecode&nchash=<?php echo getNchash();?>" title="<?php echo $lang['login_index_change_checkcode'];?>" name="codeimage" border="0" id="codeimage" onclick="this.src='<?php echo SHOP_SITE_URL?>/index.php?act=seccode&op=makecode&nchash=<?php echo getNchash();?>&t=' + Math.random()"><span></span></dd>
            </dl>
        <?php } ?>
        <ul style="border-bottom:none;">
            <li><input type="submit" class="submit" value="提交" style="background-image: none;background-color: #DB7800;
" name="Submit"></li>
            <li>提交产品预订申请后，当产品有货后我们将第一时间与您取得联系</li>
        </ul>
        <input type="hidden" value="<?php echo $_GET['ref_url']?>" name="ref_url">
    </form>
</div>